r/chiari • u/Heretolearnandadd • Jul 26 '24
Why is an epidural dangerous for a Chiari patient? Question
Could someone who has consulted with a neurosurgeon/Chiari specialist about having an epidural, please explain the exact reason why an epidural is usually not recommended? TIA!
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u/playfulpenguin1 Jul 26 '24
I was told it was due to the small risk of a nick In the spinal cord. This happens sometimes during an epidural and in healthy people it just causes a bad headache but if you have a chiari the reduction in pressure could cause it to drop further and cause paralysis. This is why I had a c section under general.
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u/SevoIsoDes Jul 26 '24
It’s not the cord, but rather the fluid-filled sack surrounding the cord. Our brains and spines live in one long sack of cerebrospinal fluid. An epidural goes just outside that sack, but if the needle causes an opening then fluid can drain from the sack. For Chiari malformation patients (or other rare things like large brain tumors) it pulls the brainstem down through the opening of the skull and can be fatal, like you said.
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u/MrsWobbles3456 Jul 26 '24
Same here. C-section with general anesthesia in 2022.
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u/Mathlete69743325 Aug 21 '24
Hi! Late to the post, but can you share a bit more about your experience under GA? Had you had decompression surgery prior to the c-section? How was recovery/bonding with the baby like afterwards? My husband and I are thinking about starting to try and my chiari is what's psyching me out about the whole thing - like how are they going to get this baby out of me?
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u/Heretolearnandadd Jul 26 '24
This is very similar to what I was told, except that it could cause death as well 😩
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u/Mathlete69743325 Aug 21 '24
Hi! Late to the post, but can you share a bit more about your experience under GA? Had you had decompression surgery prior to the c-section? How was recovery/bonding with the baby like afterwards? My husband and I are thinking about starting to try and my chiari is what's psyching me out about the whole thing - like how are they going to get this baby out of me?
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u/playfulpenguin1 Aug 21 '24
Hi, no decompression surgery as it’s not impacting my life enough for that. The bonding was great- they only give you a very light one so you aren’t under for long. My husband was holding the baby skin to skin within 5min of them both being born and I was holding them within 20min. To be fair I don’t actually remember the first 10 with my first one but the second I do. To be honest my friends who have had ‘natural’ births and have torn/had to have surgery have had to wait longer to snuggle their babies that I did. Obviously c section is a longer recovery but not as bad as I would have thought. Try to get a fentanyl drip for recovery though- really helps!
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u/mochamocha_mocha Jul 26 '24
I have had two epidurals and one emergency c-section why am I just now finding out about this???
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u/magicmamalife Jul 26 '24
Same! I had to have an epidural with my first due to severe pre-eclampsia and keeping my BP down. And then 2 csections. Yikes.
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u/Heretolearnandadd Jul 26 '24
I was honestly just as surprised. The neurosurgeon said it’s not the bearing down of vaginal birth that’s the problem, it’s the epidural or any spinal catheter!!
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u/SeaStatistician329 Jul 26 '24
I just had a baby 3/29. When they came in to do my epidural, I mentioned I have Chiari and they were like oh I have to double check everything. And they were gone for like almost 45 mins calling whoever is in charge to go over my chart and all that. She came back in and said they can do it and proceeded to give me and epidural with zero problems. It didn't even really hurt, HOWEVER because of the delay, I didn't get the epidural in enough time to feel the effects before my baby was born 🤣. She was born like 10 mins after epidural placement and I felt everything. Anyways, I have had no problems after birth regarding the epidural or anything so 🤷♀️
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u/EmilyEverglot Jul 26 '24
Epidurals puncture the dura in that surrounds the spinal cord. If you have Chiari Malformation, any puncture of the dura can cause the cerebellum tonsils to be pulled down more. If one does NOT have the actual Malformation and they have an epidural normally the dura will self heal. However, unfortunately it does not always. Especially in those with genetic connective tissue disorders like Ehler's Disorder Syndrome. If it does not heal it can cause the cerebellum tonsils to be pulled down. This is called Acquired Chiari. The puncture in the dura in both cases causes a CSF leak. In both cases the CSF leaks can be treated by a blood or a glue patch but there are very few doctors in the U.S. who know how to locate these CSF leaks, diagnose them and treat them.
Best Wishes
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u/Heretolearnandadd Jul 26 '24
Thank you for this explanation. Basically, best to avoid epidurals. I always thought it was the bearing down part that could further Chiari issues. Clearly epidural is the clear evil of the 2.
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u/nadia_0307 Jul 26 '24
I had the decompression surgery and was cleared for natural birth with epidural. I met with my OB, my neurosurgeon and an anesthesiologist who looked at my current scans, and they are all confident that I am able to have spinal medication. There are the same risks as everyone else of course, but I was told I’m not at any more risk than the average non-Chiari patient. I am not pregnant yet, but I think I would play it by ear, if my Chiari symptoms come back during pregnancy, I might choose to have a c-section. Better safe than sorry.
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u/Living-Lake-1791 Jul 26 '24
I was told to avoid a spinal tap with chiari, but otherwise had 4 epidurals+c-section before I was diagnosed. I had epidural steroid injections in my neck two weeks ago.
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u/AlarmedCarrot3555 Jul 27 '24
I didn’t find out I had chiari until after the birth of my son. I was induced, had the epidural placed, but did not progress fast enough (24hrs per hospital policy) so I had to have a C-section. The epidural only worked on half of my body so I was put under general. I had the worst dizziness & headaches after and it took almost 7 months to be diagnosed with Chiari & about two years to get the headaches under control. My neuro has been searching for a neurosurgeon but we live pretty far out from anywhere so insurance is a problem. I’m currently pregnant with baby #2 & have let my ob know & we’ll be meeting with anesthesiologist soon to discuss what would be the best option. I had no idea it could even cause an issue but thinking back it makes sense as to why my headaches & dizziness were so bad.
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u/Heretolearnandadd Jul 27 '24
Oh boy! I’m sorry for your experience. Can you please give us an update on what they recommend? My first birth with epidural was a dream! Not having the option makes me so nervous.
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u/Best-Proposal9049 Jul 28 '24 edited Jul 28 '24
I had my baby girl last month. Neurosurgeon cleared me for an epidural and natural birth six months before I went into labor. I got to the hospital, and the anesthesiologist surprised me by telling me that he didn’t feel comfortable doing one, I’d have to do it the old fashioned way. 🫠
But, my little one didn’t want to come out. My water was broken for thirty hours, and I was having contractions, but I wasn’t dilating at all.
They ended up doing a c-section, and had to put me all the way under since I couldn’t have the epidural. Sounds like you may have one on the way. Best of luck to you!
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u/Heretolearnandadd Jul 28 '24
Thanks for sharing. I was so surprised when my neurosurgeon was so strict about no epidural, even though I am pretty asymptomatic and have a milder herniation. He said I need to consult with an anesthesiologist for other options. I am terrified of natural birth. How was your experience with your GA c-section?
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u/spacedog1120 Jul 31 '24 edited Jul 31 '24
I had an epidural with my planned C-section, we consulted anesthesia and a neurosurgeon before. It was a whole thing though when I showed up for my C-section regardless cause they didn't see the notes or whatever. They placed mine with an ultrasound to ensure good placement. I didn't have any issues thankfully, I'm also very happy I chose a C-section. Pushing would have caused me symptoms for sure, a lot of lifting and stuff makes me dizzy sometimes.
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u/Heretolearnandadd Jul 31 '24
Ohhhhh thank you for telling me about the ultrasound helping with placement. I am going to have to consult with an anesthesiologist and discuss options. I’m glad your choice was the right one for you!
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u/rxcroyale Jul 26 '24
I'm assuming it varies person to person. I have a 9mo old and had an epidural. I had to consult with my neurosurgeon and maternal fetal medicine to get cleared and they said I was clear for whatever type of birth and pain management I chose...
I will say, I had a perfectly placed epidural and my God does it hurt. It's like an arthritis pain. When I bend too much or the weather gets bad, it kills me! Which is all the time with a 9mo old! I just told my mom, the pain of childbirth might have had a better recovery than this...
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u/Heretolearnandadd Jul 26 '24
Thanks for sharing. I wish we could travel to the future and see which one is worse 😂
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u/Optimal-Cap1441 Jul 27 '24
I decided diring my 2nd pregnancy that I would likely get an epidural because the pain during the labor itself could have caused me to have more dire complications than with a natural delivery. I had a very very hard time with that pregnancy as it was.
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u/meerlyacat Jul 28 '24
I didn't know the pain of the birth could also put us at risk. I had one baby 16yrs ago, and I knew I couldn't have an epidural. I was so frightened of needing a caesarian, coz I was worried about the bonding experience being in jeopardy with not actually being able to be awake to witness his first moments of life with having to have a general anaesthetic for it. Luckily I was able to have a vaginal birth
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u/Optimal-Cap1441 Jul 28 '24
The contractions in my first time were so hard I was having headaches so as one could imagine it made rest IMPOSSIBLE and it escalated my BP (as in after headaches etc) But I will also and ALWAYS stress that every case is different and you should meet with both your obgyn and your neurosurgeon.
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u/Heretolearnandadd Jul 27 '24
I totally understand and respect that. How has your decision worked out for you since the birth?
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u/fantasmaspastic Jul 26 '24
During my second pregnancy, I met with an anaesthesiologist to discuss my options. She told me that it is a growing belief that epidurals can CAUSE chiari.